Vogt Bruno, Bochud Murielle, Burnier Michel
Department of Medecine, Service of Nephrology and Hypertension, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
Semin Nephrol. 2007 Sep;27(5):529-37. doi: 10.1016/j.semnephrol.2007.07.009.
Overweight and obesity are associated with arterial hypertension. Given the large increase in the obesity prevalence worldwide, the number of obese patients with hypertension is likely to increase substantially in the near future. Overweight and obese patients are exposed to an important metabolic and cardiovascular risk. The understanding of the mechanisms linking obesity to hypertension is important for specific prevention and therapy in this population. There is some evidence that obesity is associated with an increased aldosterone level. To date, 2 mechanisms may explain the interaction of fat tissue with the renin-angiotensin-aldosterone system, and therefore explain, in part, obesity-related hypertension. First, human adipose tissue produces several components of the renin-angiotensin-aldosterone system, mainly adipose tissue-derived angiotensinogen. Second, increased fatty acid production in the obese patient, especially nonesterified fatty acids, might stimulate aldosterone production, independent of renin. A better understanding of these mechanisms might have implications for the management of hypertension in overweight and obese patients. Because aldosterone also is associated with blood glucose and blood lipids, selective aldosterone blockade may represent a particularly attractive therapeutic strategy in obese patients with a clustering of cardiovascular risk factors.
超重和肥胖与动脉高血压相关。鉴于全球肥胖患病率大幅上升，肥胖高血压患者的数量在不久的将来可能会大幅增加。超重和肥胖患者面临着重要的代谢和心血管风险。了解肥胖与高血压之间的联系机制对于该人群的特异性预防和治疗至关重要。有证据表明肥胖与醛固酮水平升高有关。迄今为止，有两种机制可以解释脂肪组织与肾素 - 血管紧张素 - 醛固酮系统的相互作用，因此部分解释了与肥胖相关的高血压。首先，人体脂肪组织产生肾素 - 血管紧张素 - 醛固酮系统的几种成分，主要是脂肪组织衍生的血管紧张素原。其次，肥胖患者脂肪酸产量增加，尤其是非酯化脂肪酸，可能会刺激醛固酮的产生，而与肾素无关。更好地理解这些机制可能对超重和肥胖患者的高血压管理产生影响。由于醛固酮也与血糖和血脂有关，选择性醛固酮阻断可能是肥胖合并心血管危险因素患者特别有吸引力的治疗策略。
